On November 1st, the open enrollment period for the Affordable Healthcare Act (ACA) begins. The 2018 open enrollment runs from November 1st to December 15th and is a crucial time to reach a critical number of under and uninsured individuals in order to get them covered. With enrollment during that period coverage would start on January 1, 2018. This years period is shorter than the 3-month period last year and has been reduced to 6 weeks. According to reports, government cutbacks in the form of … [Read more...] about Texans to face new obstacles as Obamacare open enrollment nears with government cuts
Procedural Requirements for Requesting Additional Medicaid Beds through an Exemption
Provider Letter 2017-30 Addressed to Nursing facilities. DADS reports that to qualify for a high occupancy rate exemption and receive an allocation of additional Medicaid beds when it has high occupancy rates, a NF must demonstrate that it has had an occupancy rate of at least 90 percent for nine of the 12 months prior to the application. A NF may not rely on data for any month before a previous increase. See the provider letter for more details. Medicaid Bed Allocation Requirements for high … [Read more...] about Procedural Requirements for Requesting Additional Medicaid Beds through an Exemption
Billing for Preadmission Screening and Resident Review Assessments and Services
Information Letter No. 17-20 - Addressed to Nursing Facility Providers on how to bill for Therapies, Customized Manual Wheel Chairs (CMWC) and Durable Medical Equipment (DME) reimbursed through the Preadmission Screening and Resident Review (PASRR) program at HHSC. Nursing facility providers must review the resident’s Medicaid Eligibility and Service Authorization Verification (MESAV) to verify a service authorization has beencreated and to determine which service code was used. Nursing facility … [Read more...] about Billing for Preadmission Screening and Resident Review Assessments and Services
Why Planning for Long-Term Care Services is A MUST For Aging Individuals
Long-term care services are an important aspect of your health care plans and for that reason, it's important to inform your loved ones and providers about your health care needs for the future. In fact, most adults should plan for long-term and even palliative care as it benefits the candidate when it comes to supportive care in the form of basic living needs such as bathing, dressing, personal care, housekeeping, meal preparations and even medical help. According to news reports, research … [Read more...] about Why Planning for Long-Term Care Services is A MUST For Aging Individuals
Ban on nursing home arbitration agreement officially lifted by CMS.
Ban on nursing home arbitration agreement officially lifted by CMS.Upheld by the Centers for Medicare & Medicaid Services under the Trump Administration, according to reports, the ban on nursing home arbitration clauses has been lifted. CMS Issued the 'Proposed Revision Requirements for Long-Term Care Facilities’ Arbitration Agreements on its website. Obama-era regulation previously stopped nursing homes from forcing patients and their families to sign binding arbitration agreements, … [Read more...] about Ban on nursing home arbitration agreement officially lifted by CMS.
Presentation to the House Appropriations
Committee on Article II: Overview of Medicaid Cost Reporting for Long Term Services and Supports ProgramsMedicaid Rate Setting Methodologies •Methodologies vary based on type of service, whether service has a Medicare equivalent, federal law, and available data.• Acute Care (physicians, CORF/ORF, HHA, DME, medical supplies, SHARS, MAC)• Resource-based Fees: equal to Medicare Relative Value Unit (RVU) for the service multiplied by applicable Medicaid conversion factor.• Access-based Fees:• … [Read more...] about Presentation to the House Appropriations
Texas Medicaid and CHIP – STAR Kids
OverviewSTAR Kids will be the first Medicaid managed care program specifically serving youth and children who get disability-related Medicaid. Beginning Fall 2016, children and youth age 20 or younger who either receive Supplemental Security Income (SSI) Medicaid or are enrolled in the Medically Dependent Children Program (MDCP) will receive all of their services through a STAR Kids health plan. Children and youth who receive services through other 1915(c) waiver programs will receive … [Read more...] about Texas Medicaid and CHIP – STAR Kids
Medicaid Hospice Rates for Federal Fiscal Year 2015
The Texas Health and Human Services Commission (HHSC) approved rate changes for theMedicaid Hospice program based on information provided by the Centers for Medicare andMedicaid Services (CMS). The new rates, which are retroactive to 10/01/2014, can be accessedthrough the HHSC Rate Analysis website at the following address:http://www.hhsc.state.tx.us/rad/long-term-svcs/hospice/index.shtml For federal fiscal year 2015, CMS approved two payment rates following the quality reportingrequirements … [Read more...] about Medicaid Hospice Rates for Federal Fiscal Year 2015
Program Provider Responsibilities Regarding Acute Care Services
Information Letter No. 14-81 addresses the impact of the carve-in of acute medical careservices into managed care for certain persons enrolled in the Home and Community-basedServices (HCS) or Texas Home Living (TxHmL) programs as required by Senate Bill (SB)7 (83rd Legislature, Regular Session, 2013) and the impact the carve-in will have onexpectations for program providers, including compliance with program rules as describedin Texas Administrative Code (TAC), Chapter 9, Subchapter D for HCS … [Read more...] about Program Provider Responsibilities Regarding Acute Care Services
Request for Medical Service Planning Documents for Individuals Residing in ICF/IID
DADS has issued Information Letter 14-40 / Provider Letter 14-15 regarding the Expansion of Medicaid Managed Care Acute Care Services – Request for Medical Service Planning Documents for Individuals Residing in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions. In accordance with the provisions of Senate Bill 7, 83rd Texas Legislature, Regular Session, 2013, an eligible individual residing in an Intermediate Care Facility for Individuals with … [Read more...] about Request for Medical Service Planning Documents for Individuals Residing in ICF/IID